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Birmingham South Central Clinical
Commissioning Group (BSC CCG)
BSC Pre-Diabetes Demonstrator Pilot
Local Improvement Scheme (LIS) 2015/16
1st October 2015 – 30
th September 2016
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Table of Contents
The BSC CCG Pre-Diabetes Demonstrator Pilot Service is a Local Improvement
Scheme. ..................................................................................................................... 4
Scope of Service ........................................................................................................ 4
Background ............................................................................................................. 4
National Diabetes Prevention Scheme ................................................................ 4
BSC CCG Service Model ..................................................................................... 5
*Health Trainer Programme ................................................................................. 5
Aim of Service...................................................................................................... 6
Success Measures for the Scheme ..................................................................... 6
Entry Criteria ........................................................................................................ 6
Record Keeping/Data Collection .......................................................................... 6
Interdependencies ............................................................................................... 7
Training / Education ................................................................................................ 7
Commissioning Responsibilities of BSC CCG ........................................................ 7
Service Delivery ......................................................................................................... 8
Service Model ........................................................................................................ 8
Indicator 1 (A) - Pre-Diabetes Demonstrator ....................................................... 8
Outcome Measure ............................................................................................... 9
Indicator 1(B) - Pre-Diabetes Demonstrator ........................................................ 9
Outcome Measure ............................................................................................. 10
Outcome Measure ............................................................................................. 11
Service Exclusions ............................................................................................. 11
Service Read Codes .......................................................................................... 12
Quality Assurance .............................................................................................. 12
Health Care Standards ...................................................................................... 13
Staff Competence .............................................................................................. 13
Consent and Confidentiality ............................................................................... 13
Record Keeping and Verification ....................................................................... 13
Governance ....................................................................................................... 14
Safeguarding ..................................................................................................... 14
Risk Management .............................................................................................. 14
Complaints ......................................................................................................... 15
Purpose & Rationale ............................................................................................. 15
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Expected outcomes of scheme .......................................................................... 16
Monitoring & Financial Details ........................................................................... 16
Monitoring ............................................................................................................. 16
Monitoring Requirements ................................................................................... 17
End of Year Submission Dates for 2015/16 ....................................................... 17
Project Evaluation .............................................................................................. 17
Financial Details ................................................................................................ 18
Practice Payments ............................................................................................. 18
Pre-Diabetes Payment schedule: ...................................................................... 18
Sign Up Form..................................................................................................... 19
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The BSC CCG Pre-Diabetes Demonstrator Pilot Service is a Local Improvement
Scheme.
NHS England has delegated certain primary care commissioning functions to
Birmingham South Central CCG under section 13Z of the NHS Act, as set out in the
Delegation Agreement between the CCG and NHS England. The Delegated
Functions include decisions in relation to the commissioning, procurement and
management of Primary Medical Services Contracts, including but not limited to
decisions in relation to Local Improvement Schemes.
Where Birmingham South Central CCG wishes to use resources for improvements in
services provided under the GP contract as a fully delegated CCG we need approval
from the relevant CCG Committee, this being the Primary Care Committee. The
Local Improvement Scheme process is in line with the Delegation Agreement. Local
Improvement Schemes can cover:
Incentives for improvements in the quality of primary medical care services; or
Funding to support activities such as clinical audit and peer review.
BSC CCG has received approval from the Primary Care Committee to use resources
from our budget to support a BSC CCG Pre-Diabetes Demonstrator Pilot Service
within the scope of a Local Improvement Scheme (LIS).
This document constitutes the agreement between the GP practice and Birmingham
South Central CCG in regards to the provision of the BSC CCG Pre-Diabetes
Demonstrator Pilot Scheme.
It is incumbent on all practices that sign up to this LIS to ensure that they adhere to
all the contractual requirements within their GMS/PMS contract whilst participating in
this LIS. Failure to do so may result in formal contract sanctions being taken by the
CCG.
Scope of Service
Background
National Diabetes Prevention Scheme
In March 2015, Birmingham South Central Clinical Commissioning Group (CCG) was
selected as one of seven innovative demonstrator sites across the country to pilot a
national diabetes prevention scheme to test a range of interventions that aim to
reduce the incidence of Type 2 diabetes by 2025. As a demonstrator site, the CCG
will receive national support from NHS England and Public Health England to plan
and implement this new initiative.
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The overall aim of the scheme is to increase by 6% year- on- year the number of
people identified to be at risk from developing diabetes and help them make changes
so that they fall out of the risk category.
It is anticipated that following the conclusion of the demonstrator site pilots, the
schemes will be evaluated to help understand whether any of the initiatives rolled out
have helped to reduce the incidence of pre diabetic patients in local populations. If
any of the schemes are able to successfully demonstrate this impact, the intention is
that they act as the future blueprint for national pre-diabetic care.
BSC CCG Service Model
One of the key responsibilities of the CCG is to work in collaboration with local
providers to develop a diabetes risk reduction programme. It is intended that the
service model will support practices to signpost patients tested and classified to be at
risk of developing diabetes into a number of lifestyle programmes that focus upon
exercise, lifestyle and weight management support. The ambition is that participation
in the programme will empower patients to make changes to their lifestyles that will
help them to fall out of the at risk category for developing diabetes in the longer term.
Gateway Family Services and Health Exchange have each been commissioned to
deliver the CCG’s diabetes risk reduction programme and both services have
individual capacity to see a maximum of 750 patients.
When each the scheme partners has reached the maximum number of patients that
they have been commissioned to see, practices will be notified that the capacity of
the scheme has been reached. When practices receive this notification, they will be
asked to signpost any further patients that they identify as suitable for this service
into the *Health Trainer programme.
Patients who are referred to the Health Trainer programme should be coded as
follows:
Referral to Health Trainer (8HlF)
Referral to Health Trainer Declined (8IAL)
*Health Trainer Programme
Individuals who are aged over 16 years and live in the Birmingham area can be
referred into the Gateway or Health Exchange Health Trainers Programme, which
offers between six and eight free one-to-one advice and support sessions with a
personalised Health Trainer. Patients referred into these services will receive a
personalised health plan, with appointments made at a time and place to suit the
individual in addition to information about other local services that can help them to
achieve their personal goals.
The Gateway or Health Exchange Health Trainer Programme will help to identify the
lifestyle changes that individuals need to make and then provide the support,
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encouragement, motivation and practical help that people need to maintain the
momentum of the lifestyle changes that they make.
*It is important to note that patients who are referred directly into the Health Trainer
programme will not form part of the service evaluation for the Demonstrator Pre
Diabetes Programme. Therefore, the management and audit of patients referred into
these services (although Read Coded) will not be included within the scope of this
specification.
Aim of Service
The strategic aim of the scheme is to increase by 6% year- on- year the number of
people identified to be at risk from developing diabetes and help them make changes
so that they fall out of the risk category.
At a local level, the key aim of the service is to support practices to signpost patients
on their High Risk of Diabetes Register to the BSC CCG diabetes risk reduction
programme delivered by Health Exchange and Gateway Family Services.
Practices will be required to monitor and Read Code the outcomes for all pre-
diabetic patients who are signposted to the risk reduction programme using the
codes identified in Section 3.3 of the service specification.
Success Measures for the Scheme
The success measures of the scheme will include:
Universal practice sign up to the scheme
Providers reaching full capacity for their individual diabetes risk reduction
programmes due to BSC CCG pre-diabetic patient engagement
Reduction in the number of BSC CCG patients on Pre-Diabetic Risk Registers
Entry Criteria
Practices wishing to join up to the scheme should complete the sign up form detailed
on Page 16 of the service specification.
Record Keeping/Data Collection
Data will only be collected that can be justified to be used productively to improve
patient care
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Data will be used to
Collate feedback/good practice to support practice and network peer review
Help the CCG improve the quality and performance of Secondary &
Community Providers
Support GP appraisal
Verification/audit of the LIS
Interdependencies
The interdependencies that will be required to support delivery of this LIS include the
following:
Practices having consistent access to capacity within the diabetes risk
reduction programme delivered by Health Exchange and Gateway Family
Services.
Access to monthly practice and patient level up take data split by provider
Access to monthly practice and patient level attendance data split by provider
Access to monthly practice and patient level ‘Do Not Attend’ (DNA) data split
by provider
Access to monthly practice and patient level completion data split by provider
Access to monthly practice and patient level Health Trainer up take data split
by provider
Training / Education
The service will be supported by the delivery of:
Pre-Diabetes Education/ Training Programme
Commissioning Responsibilities of BSC CCG
BSC CCG will:
Collect data on the delivery and impact the intervention described within this
specification
Use this data to monitor practice performance on a quarterly basis and
provide feedback to practices bi-annually
Support practices with clinical advice and signposting to tools and resources
that will enhance delivery of the LIS requirements
Provide mandatory training workshops that will support delivery of the LIS
requirements
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Carry out visits to randomly selected practices to monitor any issues arising
and quality assure activity delivered as part of this LIS
Reserve the right to review or update the LIS in line with changes to National
Clinical Guidelines or changes in local policy
Reserve the right to terminate the LIS with a notice period of 3 months.
Service Delivery
Service Model
The service has been commissioned as a 12 month pilot and will run from the 1st
October 2015 to 30th September 2016.
Indicator 1 (A) - Pre-Diabetes Demonstrator
Practices signing up to this agreement will be commissioned to send out one single
mail shot invitation to patients on their High Risk of Diabetes Register (HbA1c of 42 –
47mmol/mol) who are between 18 years and 75 years and have a Body Mass Index
(BMI) of 27.5 or more. The mailshot should be completed by 31st December 2015.
Confirmation that this mailshot has been completed is required to be input onto the
GPORT System by 31st December 2015.
The invitation letters will signpost patients to the diabetes risk reduction programme
by describing the purpose and structure of the service and the reasons why an
invitation has been extended to the patient. This will help patients to understand the
benefits of joining the scheme.
The invitation letter sent out to patients highlighted in this Section will also include
details of the location of programme venues and information / contact details relating
to how the patient can join the scheme.
Each practice will be allocated a designated service provider so that they can amend
their invitation letter to highlight this provider before they send out their practice
mailshot.
The letter template and a GP practice list by designated provider will be made
available through the GPORT System
When the mailshot has been sent out, details should be entered onto each individual
patient’s clinical record using the Read Code below:
Healthy lifestyle programme offered (9m44)
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If a patient is directly signposted to the programme through an opportunistic GP /
Nurse face to face contact, practices should enter the following Read Code onto the
patient’s clinical record:
Referral to healthy lifestyle programme (8HIu)
Referral to healthy lifestyle programme declined (9m43)
Practices will be notified on a monthly basis by service providers’ information
regarding the number and names of patients who have joined the scheme and have
attended their first and / or follow up sessions.
Details should be entered onto the patient’s clinical record using the Read Codes
below:
Healthy lifestyle programme commenced (9m40)
Healthy lifestyle programme DNA’d (9N4v)
Healthy lifestyle programme not completed (9m41)
Healthy lifestyle programme completed (9m42)
Outcome Measure
90% of all patients aged between 18 years and 75 years who are included on the
High Risk of Diabetes Register (patients with an HbA1c of 42 – 47mmol/mol) and
have a BMI of 27.5 or more should be signposted by mailshot or face to face referral
to attend the risk reduction programme.
Capacity of the Diabetes Risk Reduction Programme
If capacity of the risk reduction programme is not reached following the completion of
the process highlighted in Section 3.1.1 of the scheme, the CCG reserves the right to
request that practices repeat the process for the patient group highlighted in Section
3.1.2.1 of the scheme – Please refer to Indicator 1 (B) Pre-Diabetes Demonstrator.
Practices will be notified by the Pre - Diabetes Demonstrator Project Group should
this process need to be actioned.
Indicator 1(B) - Pre-Diabetes Demonstrator
As referenced above, practices will only be asked to repeat the process outlined in
Section 3.1.1. of the scheme if any additional capacity is identified by the CCG
following the completion of the first mailshot. At this point, practices will be contacted
and asked to send out one single mail shot invitation to patients on their High Risk of
Diabetes Register (HbA1c of 42 – 47mmol/mol) who are between 18 years and 75
years and have a Body Mass Index (BMI) between 25 and less than 27.5.
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The invitation letter will describe the purpose and structure of the risk reduction
programme and the reasons why an invitation has been extended to the patient. This
will help them to understand the benefits of joining the scheme. The letter will also
include details of the location of programme venues and information / contact details
relating to how the patient can join the scheme.
The letter template and a GP practice list by designated provider will be made
available through the GPORT System
Details should be entered onto the patient’s clinical record using the Read Code
below:
Healthy lifestyle programme offered (9m44)
If a patient is directly signposted to the programme through an opportunistic
GP/Nurse face to face contact, practices should enter the following Read Code onto
the patient’s clinical record:
Referral to healthy lifestyle programme (8HIu)
Referral to healthy lifestyle programme declined (9m43)
Practices will be notified on a monthly basis by service providers’ information
regarding the number, names and clinical information gathered for patients who have
joined the scheme and attended their first and / or follow up sessions.
Details should be entered onto the patient’s clinical record using the Read Codes
below:
Healthy lifestyle programme commenced (9m40)
Healthy lifestyle programme DNA’d (9N4v)
Healthy lifestyle programme not completed (9m41)
Healthy lifestyle programme completed (9m42)
Outcome Measure
90% of all patients aged between 18years and 75 years who are included on the
High Risk of Diabetes Register (patients with an HbA1c of 42 – 47mmol/mol) and
have a BMI between 25 and less than 27.5 should be invited by mailshot or face to
face referral to attend the risk reduction programme if requested by the Pre -
Diabetes Demonstrator Project Group.
Indicator 2 - Pre-Diabetes Demonstrator – Re-engagement of patients who do not
attend the programme
Practices should try and re-engage by mailshot all patients on the practice’s High
Risk of Diabetes Register between 18 years and 75 years with a Body Mass Index
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(BMI) of 27.5 or more that have been identified by the provider and read coded by
the practice to be in one of the following groups:
Patient referred but no evidence of engagement (8HIu)
(The above will be referenced by no further contact by provider to suggest
engagement)
Patient declined referral to healthy lifestyle programme through face to face
contact
Patient did not attend (DNA) Healthy lifestyle programme (9N4v)
Patient did not complete healthy lifestyle programme (9m41)
The aim of this indicator is for practices to try and re-engage patients who have
either not joined the diabetes risk reduction programme or who have at some stage
dropped out of the service 8 weeks after the initial referral was made.
The rationale for waiting 8 weeks is to allow time for the patient to initially engage
with the programme and the provider notification to be returned to the Practice.
The re-engagement letter template will be made available to practices through the
GPORT System.
Outcome Measure
90% of all patients aged between 18 years and 75 years who are included on the
High Risk of Diabetes Register and have a BMI of 27.5 or more and have not
engaged with the programme at the end of Week 8 following their first invitation,
should be followed up by mailshot and sent a second invitation to join the Diabetes
Risk Reduction Programme.
Service Exclusions
Practices are not funded to send out a second invitation to re-engage patients on
their High Risk of Diabetes Register who have a BMI between 25 and less than 27.5.
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Service Read Codes
The Read Codes to be used for the service are highlighted in the table below:
Quality Assurance
Practice Requirements
Practices participating in this LIS will be required to:
1. Work collaboratively with all stakeholders, including internal and external
clinical networks, to support the delivery of the scheme
2. Ensure that a minimum of 1 practice GP clinician and Nurse attend all
education and training sessions offered by the CCG to support the delivery of
the scheme
3. Ensure that all monitoring reports are sent to the CCG by their submission
deadlines using the approved CCG reporting templates.
Action Read
Code
Healthy lifestyle programme offered (via mailshot) 9m44
Referral to healthy lifestyle programme (through
face/telephone contact)
8HIu
Referral to healthy lifestyle programme declined 9m43
Healthy lifestyle programme commenced 9m40
Healthy lifestyle programme DNA’d 9N4v
Healthy lifestyle programme not completed 9m41
Healthy lifestyle programme completed 9m42
Referral to Health Trainer 8HlF
Referral to Health Trainer Declined 8IAL
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Health Care Standards
1. Practices providing the service defined within this agreement should have
adequate facilities available in order to enable them to provide such services
properly
2. Adequate and appropriate equipment should be available for healthcare
professionals to undertake the service defined within this agreement
3. Providers should fulfil legislative requirements for services and meet
assurance markers set out in the Standards for Better Health
(http://www.hcsu.org.uk)
4. It is expected that practice staff carrying out the initiatives within this
specification will be appropriately qualified to do so.
Staff Competence
All individuals providing the service within the scope of this agreement will need to
evidence that they have the experience and qualifications to undertake the service.
The practice will ensure that all individuals are competent to provide those aspects of
the service for which they are responsible and will make sure that all individuals keep
their skills up to date.
Consent and Confidentiality
All patients receiving care in accordance with the requirements of the LIS should be
fully informed of the purpose of the scheme. Details of their consent to be contacted
should be recorded onto their clinical record.
Practices are expected to also ensure patient confidentiality is retained in
accordance with BSC CCG’s Confidentiality and Data Protection Policy.
Record Keeping and Verification
Practices must manage data and patient records as follows:
Ensure records are accurate and kept on a secure system
Record NHS numbers of patients to allow follow up through health care
system
Audits undertaken against the agreed clinical management guidelines
Demonstrate security, safe storage, and confidentiality of data
Maintain electronic records.
All records should be kept in such a way that simple or aggregated data is readily
available and accessible if requested by the commissioner of the service.
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For verification purposes, practices will be required to keep a full data set at practice
level in line with this service specification. The CCG may request this information
from the practice to substantiate practice activity data.
Practices will be required to retain at practice level a list of patients who have been
contacted for the requirements of each of the indicators listed within the service
specification as outlined in Section 3 of the scheme. Details of this should be made
available to the CCG upon request and may be used for verification purposes during
individual practice visits if required to do so.
Governance
Any near events or serious untoward incidents must be reported using BSC CCG’s
Service Alert System. The CCG will use this information to support the review of
service provider contracts and quality indicators to help ensure the optimum quality
outcomes for their patient population.
A Practice should record all adverse incidents and these should be reported to BSC
CCG within 7 days of their occurrence. Incidents considered to be serious by the
Practice should be immediately reported to the CCG’s Clinical Governance Lead,
and the Clinical Governance Team. An adverse incident is outside of the usual
expectations associated with a particular treatment or procedure.
Diversity and Ethnicity Monitoring
BSC CCG expects any provider to show commitment to Diversity and Equality
through any appropriate means, e.g. Equal opportunities policy, patient protected
characteristics data.
Safeguarding
The Practice will ensure that:
All staff will be able to recognise indicators and act upon concerns. Their depth of
knowledge should be commensurate with their roles and responsibilities.
Staff should be made aware when they have any concerns to discuss those
concerns with a named manager or supervisor as required
All concerns should be reported through the Local Safeguarding Board (LSB).
Risk Management
Compliance with relevant legislation
Accident Reporting / Significant Event Monitoring
Department of Health 2001 Good Practice in Consent: Achieving the NHS Plan
Commitment to Patient centred Consent Practice, HSC 2001/023 DH (2006)
Safety First.
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Complaints
All complaints must comply with the Local Authority Social Services and National
Complaints (England) Regulation 2009.
Quality and Performance Indicators
Quality Area Quality Measure Measurement and
Reporting
Frequency and
Format
Threshold Consequence
of Breach
Signposting
& Referral
Signposting &
Referrals are timely
and fit clinical
criteria for service
provision
Random / Selected
Audit by Service
Commissioner
90% of all
referrals to
meet the
criteria
Remedial
Action Plan as
agreed with
Commissioner
Re-
engagement
Re-engagement is
timely and
undertaken in line
with the clinical and
operational criteria
for service provision
Random / Selected
Audit by Service
Commissioner
90% of all
referrals to
meet the
criteria
Remedial
Action Plan as
agreed with
Commissioner
Purpose & Rationale
Diabetes is a chronic and progressive disease that impacts upon almost every
aspect of life and can reduce life expectancy by up to 15 years. In the United
Kingdom (UK), the prevalence of pre-diabetes has tripled in eight years, with more
than a third of adults now considered to be at high risk of developing Type 2
Diabetes.
In the absence of intervention, the majority of pre- diabetic patients are likely to
develop Type 2 diabetes within five to ten years. However, various studies have
shown that a specific range of lifestyle interventions can significantly reduce the risk
of developing diabetes. The identification and management of pre-diabetes therefore
provides a substantial opportunity for preventing the future burden of Type 2
diabetes within BSC CCG.
Pre-diabetes is now recognized as a reversible condition that increases an
individual’s risk for developing diabetes. Lifestyle risk factors for pre-diabetes include
being overweight and physical inactivity. Evidence suggests that personalised
lifestyle and educational interventions can delay or even reverse the disease process
for this patient group. Research studies have found that moderate weight loss and
exercise can prevent or delay type 2 diabetes among adults at high-risk of diabetes
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The service model will support practices to signpost patients tested and classified to
be at high risk of developing diabetes into a number of lifestyle programmes that
focus upon exercise, lifestyle and weight management support. The ambition is that
participation in the programme will empower patients to make changes to their
lifestyles that will help them to fall out of the at risk category for developing diabetes
in the longer term.
The rationale for the LIS Scheme is to test a range of interventions that aim to
reduce the incidence of Type 2 diabetes by 2025.
Expected outcomes of scheme
This specification will result in the following outcomes:
Reduce the number of BSC patients who are identified to have pre-diabetes
Reduce the number of BSC pre-diabetic patients who progress on to develop
Diabetes
Improve patient experience of care
High levels of patient satisfaction by empowering the patient to be involved in
decisions about the care they receive
High levels of patient satisfaction by empowering the patient to make sure that
they access care/treatment in a timely manner
Strengthen continuity of care
Increase the number of BSC pre-diabetic patients who exercise regularly
Reduce the number of BSC pre-diabetic patients who have a BMI of over 25
Monitoring & Financial Details
Monitoring
As a minimum, practices will need to ensure that they keep activity information for service delivery at an individual patient level.
The practice is required to supply the CCG with such information it may reasonably request for the purposes of monitoring the contractor’s performance of its obligations under the LIS.
It is anticipated that monitoring will be undertaken annually. However, the CCG reserves the right to request activity information on a quarterly basis if required. This request will be made by email to the practice.
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Monitoring Requirements
Using the Read Codes Identified in Section 3.3, practices will be required to submit monitoring requirements in accordance with the outcome measures for the service. Details are outlined between sections 3.1.1.2. to section 3.1.3.1.of the scheme.
End of Year Submission Dates for 2015/16
Indicators Submission Requirements Submission Deadline
Pre-Diabetes Demonstrator Indicator 1 (A)
End of Year Activity Summary including:
Total number of patients on High Risk of Diabetes Register with a BMI over 27.5
Number of patients who join scheme
Number of patients who decline scheme
Number of patients who attend first appointment
Number of patients who DNA after first session
Number of patients who do not complete the scheme
Number of patients who complete scheme
End of Year
Pre-Diabetes Demonstrator Indicator 1(B)
End of Year Activity Summary including:
Total number of patients on High Risk of Diabetes Register with a BMI between 25 and under 27.5
Number of patients who join scheme
Number of patients who decline scheme
Number of patients who attend first appointment
Number of patients who DNA after first session
Number of patients who do not complete the scheme
Number of patients who complete scheme
End of Year
Pre-Diabetes Demonstrator Indicator 2
End of Year Activity Summary including:
• Number of patients who decline scheme at first invitation and then re-engage
End of Year
Project Evaluation
A key element of the pilot is to externally validate the outcomes of the project,
including the range and success of the interventions offered.
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Details of this external evaluation have yet to be agreed. However, practices signing
up to this scheme will be expected to support the delivery of this evaluation by
helping to provide/complete any audit information required for independent external
analysis.
Financial Details
To deliver the requirements of the scheme, practices will be paid £0.30p per patient based upon their weighted practice population.
Practice Payments
Note: This LIS is over two financial years 2015/16 and 2016/17, as it runs from 1
October 2015 to 30 September 2016. Payments will be made to practices quarterly
in advance.
Payments for financial year 2015/16
Quarters 3 and 4 was paid in advance, by 30 November 2015. The reason was to
support Practices in completing the first mailshot by 31st December 2015.
Payments for financial year 2016/17
Quarter 1 payment for 2016/17 was paid at the end of March 2016. Quarter 2
payment for 2016/17 was paid in June 2016.
Pre-Diabetes Payment schedule:
Financial Year Financial Quarters Payment Month
2015/16 Quarter 3 (Oct – Dec 15)
Quarter 4 (Jan – Mar 16)
November 2015
2016/17 Quarter 1 (Apr – Jun 16 March 2016
Quarter 2 (Jul –Sep 16) June 2016
The CCG reserves the right to audit practice activity and plans as required.
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Clinical Templates
Sign Up Form
This document constitutes the agreement between the GP practice and Birmingham
South Central CCG in regards to the provision of the BSC Pre-Diabetes
Demonstrator Pilot Scheme (1st October 2015 – 30th September 2016).
Practice sign up to this service was via the GP Online Reporting Tool (GPORT). The
sign up options on the GPORT system was available to practices from Monday 12th
to Friday 23rd October, 2015.